{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:15:43Z","timestamp":1787760943256,"version":"build-2784847793"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Quilombola communities in the Brazilian Amazon face persistent social and territorial inequities that shape health outcomes and access to care. Geographic isolation, limited transportation, centralization of specialized services, and socioeconomic disadvantages contribute to unequal opportunities for timely diagnosis and treatment. Understanding how these determinants interact with patterns of multimorbidity is essential for guiding equiTable health policies and strengthening primary care in remote territories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional epidemiological study was conducted with 518 adults from nine quilombola communities in Santar\u00e9m, Par\u00e1. Data were collected through household surveys addressing sociodemographics, self-reported diseases, service utilization and resolvability. Geographic coordinates of communities and health services were mapped to classify accessibility as high, medium or low. Diseases were converted into a binary matrix to estimate prevalence and identify multimorbidity (\u22652 conditions). Statistical analyses included chi-square tests, ANOVA, Spearman correlations and heatmap visualization. A Composite Access Index (CAI) integrating geographic distance, epidemiological burden and service-use indicators was developed. A Random Forest model was used to identify conditions most strongly associated with multimorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Communities showed marked territorial heterogeneity. P\u00e9rola do Maic\u00e1 had the highest accessibility, while Ituqui, Tiningu and Murumuru presented substantial geographic and logistical barriers. Service utilization ranged from 42.9% to 95.0%, and most communities relied on care outside their territory (70\u201395%). Complete problem resolution was reported by 72.5% of participants, though with variation among communities. The CAI identified Ituqui (0.550), Tiningu (0.480) and Murumurutuba (0.331) as the most vulnerable territories. The Random Forest model achieved 93.6% accuracy, with hypertension, diabetes, musculoskeletal diseases, arthritis\/rheumatism and heart disease emerging as key predictors of multimorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Findings indicate that social and territorial determinants are strongly associated with inequities in access to health services, continuity of care, and disease burden across quilombola communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Geographic barriers and the distribution of health services are associated with distinct patterns of multimorbidity and health service access among quilombola populations. Strengthening primary care, transportation, and diagnostic support may help mitigate inequities and improve health conditions in remote Amazonian territories.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344043","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:24:51Z","timestamp":1774632291000},"page":"e0344043","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Geographical barriers and multimorbidity in quilombola territories of the amazon region"],"prefix":"10.1371","volume":"21","author":[{"given":"Leanna Silva","family":"Aquino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen Mara","family":"Fernandes da Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria Valentim","family":"Aguiar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar Ferreira","family":"Fernandes Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheyla Mara Silva","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiane Costa","family":"Quaresma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valney Mara","family":"Gomes Conde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00e1dia Vic\u00eancia","family":"do Nascimento Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos Manoel","family":"Honorato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veridiana Barreto","family":"do Nascimento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Augusto","family":"Barros Conde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franciane","family":"de Paula Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4255-8988","authenticated-orcid":true,"given":"L\u00edvia de Aguiar","family":"Valentim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"pone.0344043.ref001","volume-title":"Health inequities and their causes [Internet]","author":"World Health Organization","year":"2018"},{"issue":"9464","key":"pone.0344043.ref002","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/S0140-6736(05)71146-6","article-title":"Social determinants of health inequalities","volume":"365","author":"M Marmot","year":"2005","journal-title":"Lancet"},{"key":"pone.0344043.ref003","doi-asserted-by":"crossref","DOI":"10.1590\/1518-8345.0945.2687","article-title":"Social inequalities and access to health: challenges for society and the nursing field","volume":"24","author":"RC Fiorati","year":"2016","journal-title":"Rev Lat Am Enfermagem"},{"key":"pone.0344043.ref004","author":"Commission on Social Determinants of Health (CNDSS)","year":"2008"},{"issue":"9","key":"pone.0344043.ref005","article-title":"Access and integrality in the health care of quilombola women: challenges to equity","volume":"11","author":"GMC Torres","year":"2022","journal-title":"Res Soc Dev"},{"issue":"4","key":"pone.0344043.ref006","article-title":"Social determinants of health as an impact factor in health care for quilombola populations: a systematic review","volume":"24","author":"EO Amador","year":"2024","journal-title":"Rev Eletr\u00f4nica Acervo Sa\u00fade"},{"key":"pone.0344043.ref007","first-page":"473","article-title":"Public policies and access to health services in quilombos of the Amazon. 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